Ophthalmic Disorders Flashcards
Exclusions for Self-Treatment
- Eye Pain
- Blurred vision not associated with use of ophthalmic ointments
- Sensitivity to light
- History of contact lens wear
- Blount trauma to the eye
- Chemical exposure to the eye
- Eye exposure to heat, excluding sun exposure
- Symptoms that have persisted for greater than 72 hours
Dry Eye (Sx, Meds)
Symptoms:
- white or mildly red eye
- sandy, gritty sensation
- excess tearing
- difficulty wearing contact lens
Ocular Lubricants:
- artificial tear solutions
- non medicated ophthalmic ointments
Artificial Tear Solutions: Dosage/AEs
Dosage/Administration Guidelines:
- Mild dry eye: low viscosity tears 1-2 times/day
- Moderate dry eye: low viscosity tears 3-4 times/day or high viscosity tears
- Severe dry eye: add nighttime use of ointment + non preserved tears prn
Adverse Effects:
- Toxicity from preservatives increases as number of drops per day increase (i.e. benzalkonium chloride (BAK), benzethonium chloride)
Non-medicated Ophthalmic Ointments: Dosage/AEs
Dosage/Administration Guidelines:
- Usually twice daily but can be applied every few hours
- Bedtime application preferred to keep eyes moist during sleep
Adverse Effects:
- Blurred vision
- Hypersensitivity to preserved formulations
Treatment of Dry Eye (Product Selection/Patient Ed.)
Product Selection Guidelines
- consider preservative free or disappearing preservative formulations
- patient comfort and acceptance with clinical results
Patient Assessment
- examination of affected eye
- patient medication history
- health status
Patient Education and Counseling
- avoidance of situations causing tear evaporation
- administration of ocular lubricants
- expectation and/or referral to an ophthalmic practitioner
Allergic Conjunctivitis (Sx, Meds)
Symptoms:
- Red eye
- Watery discharge
- Itching
Treatment Options:
- Cold compress and/or avoidance/removal of allergen
1. Artificial tears prn is first consideration
2. Ophthalmic antihistamine/mast cell stabilizer if symptoms persist
3. May consider ophthalmic decongestants/ alpha-adrenergic agonist - Oral antihistamine
- Medical referral
Ophthalmic Decongestants (Name/AE/Interactions/Contra)
Phenylepherine, Naphazoline, Tetrahydrozline, Oxymetazoline
Adverse Effects:
- Rebound congestion most common, needs referral to eye care specialist
- Pupil dilation can occur with phenylephrine or naphazoline
Drug/Disease Interactions:
- Enhanced pressor effects with TCA’s, MAO inhibitors, methyldopa
- Caution in systemic hypertension, arteriosclerosis, cardiovascular disease, diabetes or hyperthyroidism
Contra:
- Use contraindicated in angle-closure glaucoma
- Use sparingly during pregnancy
- Referral to eye practitioner if symptoms not resolved within 72 hours
- Naphazoline 0.02% is FIRST choice ocular decongestant
- Less rebound congestion with naphazoline or tetrahhydrozoline
Decongestant/Antihistamine (AE/Contra)
Adverse Effects:
- Common side effects include burning, stinging and discomfort
- Pheniramine may be less stinging
Contraindications/Precautions:
- Angle-closure glaucoma patient
Antihistamine/Mast Cell Stabilizer (Name/AE/Contra)
Ketotifen: best therapy for patients with allergic conjunctivitis
Adverse Effects:
- Burning, stinging and slight discomfort on installation
Contraindications/Precautions:
- Use contraindicated in angle-closure glaucoma
Product Selection Guidelines
- Safest and most effective treatment for patients with allergic conjunctivitis
Viral Conjunctivitis (Sx/Treatment/Refer)
Symptoms:
- Pink eye with watery discharge
- Eye discomfort and sensation of foreign body in eye
- Low grade fever and swollen lymph glands
- Occasional blurred vision
NonPharm: hygiene, washing hands, disposal of tissues, no sharing
Pharm: artificial tears and topical decongestants prn
Refer if loss of vision or sx > 3 weeks
Corneal Edema (Sx/Med)
Symptoms:
- From contact lens overwear, corneal damage, fluid accumulation in the cornea
- Hallmark symptoms of HALOS or STARBURSTS around lights
- Diagnosis by eye practitioner
USE topical hyperosmotic formulations!
Hyperosmotics (Sodium Chloride)
Dosage/Administration:
- 1st line treatment NaCl 2% (1-2 gtts qid)
- 2nd line treatment NaCl 2% + NaCl 5% ung (qhs)
- 3rd line treatment NaCl 5% (1-2 gtts qid) + NaCl 5% ung (qhs )
Patient Education/Counseling:
- Referral if damaged corneal epithelium
- NaCl 2% preferred for long term therapy
Loose Foreign Substances In Eye
General Treatment Approach:
- Flush eye if reflex tearing does not remove foreign substance
- Rinse eye with sterile saline or ocular irrigant (eyewash preparation)
Ocular Irrigants:
- Cleanse ocular tissues and maintain moisture
- Used on short term basis
- Do not use for open wounds and with contact lens in place
- Avoid using eyecup because of danger of contamination
Chemical Burn (Sx, Treatment)
Etiology/Symptoms:
- Exposure to alkali, acids, solvents or irritants
- Severity depends on agent/exposure time
- Sx include pain, tearing, irritation, photophobia
Treatment:
- Copious irrigation with sterile saline or tap water
- Considered ophthalmic emergency with immediate referral
Macular Degeneration
- Age related leading cause of blindness
- Two forms - neovascular (wet) and atrophic (dry)
- Antioxidants + Zinc therapy may help atrophic form
- Evidence of patients >55 yrs benefit from antioxidants + zinc therapy
- Counsel for possible gi toxicity & hypervitaminosis
